Make sure your Medicare plan works with the doctors and hospitals you want
Provider fit can be one of the most important parts of a Medicare Advantage comparison. If you find a plan that fits, your agent can help you enroll.
Compare plans. Get help enrolling.
A licensed agent can help you review plans, check the details that matter, and enroll if you choose a plan.
Why the exact plan matters, not just the insurance company
A carrier can offer several Medicare Advantage plans in the same county, and those plans may use different provider networks. A doctor who participates with one plan from a carrier may not necessarily participate with every plan that carrier offers.
That is why provider verification should be tied to the exact plan you are considering.
California medical groups can add another layer
In many California markets, physicians participate through medical groups or independent practice associations (IPAs). For an HMO in particular, the relationship among your primary care doctor, medical group, specialists and hospital can affect where you receive care and how referrals work.
Your physician
We can help verify the exact doctor or practitioner, not just the practice name.
Your medical group
If your doctor participates through a medical group or IPA, we can help confirm that relationship for the exact plan.
Your hospital
We can help confirm the hospital or health system you prefer, especially if your specialists practice there.
Your specialists
We can help check cardiology, oncology, orthopedics and other specialty care that matters to you.
How network rules differ by plan type
HMO
You generally use the plan’s network for covered care, aside from emergencies, urgent care and certain exceptions. Referrals may be required.
HMO-POS
Some services may be available outside the HMO network under the plan’s point-of-service rules, usually at a higher cost.
PPO
You can generally receive covered services from out-of-network providers that accept the plan, but your costs may be higher.
Referral and prior authorization are not the same thing
A referral is typically permission or direction from a primary care provider to see a specialist. Prior authorization is approval from the health plan before certain services, procedures, drugs or supplies are covered. A plan can have prior-authorization requirements even if specialist referrals are not required.
Tell us who you want to keep. We can help check the rest
You don’t need a complete provider list before you start. A doctor’s name, practice, hospital or even a location can be enough for us to begin looking up the right provider.
- Primary care doctor
- Specialists you regularly see
- Preferred hospital or health system
- Medical group or IPA, if you know it
- Labs, imaging centers or outpatient facilities you use
- Preferred pharmacy
Provider networks can change, so we can help confirm participation for the specific plan and plan year as part of your review.
Ready to start?
Tell us what you know now. A licensed insurance agent can help identify and verify the remaining provider details with you.
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